ocular herpes

In Discovery Eye Foundation’s spring e-newlsetter there was an article entitled Surgery for the Surgeon, where a leading ophthalmologist talks about convincing himself to have cataract surgery. That eye doctor was Dr. Nesburn, who was willing to share with us his family’s long tradition of saving vision.

Brainwashed by Medicine

“I was brainwashed from the age of 5,” says Dr. Anthony Nesburn, medical director of The Discovery Eye Foundation (DEF). “My dad would take me on rounds at the hospital and to his office. He introduced me to medicine at a really early age.”Dr. Anthony Nesburn in UC Irvine lab
Dr. Henry Nesburn was an ophthalmologist in Los Angeles for more than four decades, and he passed his love of the specialty to his son. “I really looked up to my dad,” the younger Nesburn says. “He loved ophthalmology for the same reasons I do: You get to do medical diagnosis; you get to do wonderful surgery, where you keep people from going blind or restore vision; and you can work with people from newborns to the very elderly — they all need eye care.”

Nesburn received a telegram while he was an undergrad at UCLA, telling him he’d been accepted to Harvard Medical School. His mother started crying: “You’re going to Boston! We’re not going to see you anymore!” While he “was loathe to leave Southern California,” Harvard was too good to pass up.

Drafted by the Army out of his ophthalmology residency at Harvard in 1960, Nesburn joined the Navy instead. He followed in his father’s footsteps again, becoming a Navy flight surgeon. (Henry had volunteered during World War II.)

He went on to a Boston Children’s Hospital fellowship in infectious disease, working with Nobel laureate Dr. John Enders, whose work led to the polio vaccine and changed the face of virology. Nesburn then did his residency at Massachusetts Eye and Ear. “I was part of a special program that allowed us to do research, and I was running a research laboratory while I was a resident,” he says. “It gave me the start I needed.”

“At Mass Eye and Ear, I worked for an up-and-coming ophthalmologist and researcher to prove there was a substance that could treat herpes eye infections. We wrote a paper that included the very first antiviral ever described, and it was against herpes virus. It is the basis for today’s herpes antivirals,” Nesburn says. “I was hooked.”

He went back to Los Angeles and received NIH funding to continue his research on ocular herpes. In 1968, he joined his father’s practice half-time, spending the rest of his time doing research.

Two years later, he received a generous offer, when Rita and Morris Pynoos started DEF to fund his research. The Pynooses were grateful to Nesburn for diagnosing their son, Jon, with keratoconus (KC). “I was a second-year resident at Mass Eye and Ear, and Jon Pynoos was an undergraduate at Harvard. His parents went to see my dad, because Jon couldn’t see well, and no one could figure out what was wrong with his vision. My dad said, ‘Send him over to Tony; he’ll figure out what’s going on!’ I said to myself, ‘Holy mackerel! What happens if he has something really complicated? I’m just a newbie!’” Nesburn remembers. “Jon came in; I looked at him, and the keratoconus was so clear and easy to spot. I couldn’t imagine how his doctors didn’t see it. We got him contact lenses, and he was able to see again. When I came back to LA, the Pynooses wanted to do something to help.”

At first, DEF research focused on KC and the herpes research Nesburn was working on at the time. It soon broadened to include macular degeneration and retinal disease.

“My dad had to retire from the practice of ophthalmology at the age of 70, because of bad age-related macular degeneration (AMD). His mother and older sister had had it, as did several cousins. There was no treatment back then that helped,” Nesburn says.

“AMD is the most common cause of permanent vision loss in the elderly in the developed world. I could see where the need was,” he says. “We moved forward at DEF with two driving mantras: We wanted to do something significant in macular degeneration research and to find the cause of keratoconus.”

As a virologist in research and a corneal surgeon, Nesburn realized he needed a corneal biochemist to help with the KC research. He met Dr. Cristina Kenney at an Association for Research in Vision and Ophthalmology meeting. She joined DEF, and within 15 years, they found the chemical cause of keratoconus; they also got married.

Now nearly 80 years old, Nesburn spends most of his time “wearing three hats”: fundraising for DEF, lab research and clinical practice. His daughter, Kristin, is the third generation to join the family ophthalmology practice.

“While I’m still able, I want to try to make a difference in medicine, particularly in macular degeneration,” Nesburn says. “Macular degeneration affects so many people. This is where I want to put my energy. Luckily, as strong as it is in our family, I don’t have it … yet.

“As a researcher, my interest in putting together a program for macular-degeneration diagnosis and treatment has been because it’s a great public health problem. Yes, if I should ever get it, it might be able to help me or my family, but the first thing, as a scientist, is to try to get something to help humankind. I know it sounds sappy, but it’s true.”

Ocular herpes is caused by the type 1 herpes simplex virus, and is a common, recurrent viral infection affecting the eyes. This type of herpes virus can cause inflammation and scarring of the cornea. Herpes of the eye can be transmitted through close contact with an infected person whose virus is active.
The National Eye Institute (NEI) says an estimated 400,000 Americans have experienced some form of ocular herpes, with close to 50,000 new and recurring cases occurring each year, ranging from a simple infection to a condition that can possibly cause blindness. There are several forms of eye herpes:

Herpes keratitis is the most common form of eye herpes and is a viral corneal infection. Ocular herpes in this form generally affects only the top layer which is called the epithelium, of the cornea, and usually heals without scarring.

Stromal keratitis occurs when the infection goes deeper into the layers of the cornea. This can lead to scarring, loss of vision and, occasionally, blindness. Although the condition is rare, the NEI reports that stromal keratitis is the leading cause of corneal scarring that subsequently causes blindness in the United States.

Iridocyclitis is a serious form of eye herpes where the iris and surrounding tissues inside the eye become inflamed, causing severe sensitivity to light, blurred vision, pain and redness.

Treatment for eye herpes depends on where the infection is located in the eye – in the corneal epithelium, corneal stroma, or iris, etc.

Some ocular herpes treatments could aggravate the outbreak and therefore should be considered on a case-by-case basis.

If the corneal infection is only superficial, it can normally be alleviated by using antiviral eye drops or ointments, or oral antiviral pills over a two to three week period. In some patients, both drops/ointments and pills are used. Steroid drops can help decrease inflammation and prevent corneal scarring when the infection appears deeper in the corneal layers. Steroid drops are almost always used in conjunction with and simultaneously with antiviral drops. For those relatively few eyes where, despite the best of treatment, the virus has caused vision-impairing scars, corneal transplantation surgery is often a highly successful solution.

Although eye herpes has no cure, treatment can help control outbreaks. Studies are underway to determine better methods for managing the disease.

What you need to know about eye drops.

Have you been staring at a computer all day and your eyes are tired? Have allergies been making your eyes watery and itchy? Are your contact lenses irritating your eyes? If you have experienced any of these conditions, you have probably turned to eye drops for relief.

While eye drops are an easy and effective means of treating a number of eye issues, there are many different eye drops available, both over the counter (OTC) and by prescription. It is wise to know what your underlying condition is before trying to get relief.If your eyes are red and you may want to try a decongestant eye drop, which will shrink the tiny blood vessels in the “whites” of your eyes (sclera), but they also cause dryness so may not be a good choice if you wear contact lenses.For lens wearers you are better off with a re-wetting drop to lubricate the eye and lens making you more comfortable. Another problem with the decongestant eye drops is over use – which can cause irritation and an increased tolerance that could lead to more redness.

If you suffer from allergies and antihistamine eye drop would be the best choice for relief from itchy, watery, red and swollen eyes. They work by reducing histamine in the eye tissue.

Lubricating eye drops, also known as artificial tears, are for short-term relief caused by temporary situations such as eye strain form computer use, being tired or being outdoors in windy and/or sunny conditions. If the condition is chronic, a prescription eye drop will be the best choice.

It is important to remember that if any of the above symptoms worsen or continue for an extended period of time, it is time to see your eye doctor to determine the underlying cause of your issue and to rule out eye disease. Postponing a visit could also lead to an eye infection.

Prescription drops are used to treat a wide variety of eye diseases such as glaucoma, dry eye and the symptoms of ocular herpes. They are also used to help with healing from cataract surgery, corneal transplants, glaucoma surgery and even Lasik. it is extremely important to use them as often as your ophthalmologist recommends to improve healing and prevent infection.

Because of the ease of applying eye drops researchers are working toward using them to treat other eye diseases. Ocular herpes symptoms are sometimes treated with antiviral and steroid drops. But this only is targeted at the symptoms and not the underlying cause, the herpes simplex virus. Lbachir BenMohamed, PhD and Steven Wechsler, PhD at the University of California, Irvine, Gavin Herbert Eye Instittue have been working to determine what reactivate the herpes simplex virus and develop an eye drop that would either stop the reactivation of the virus or kill it.

Using eye drops to treat age-related macular degeneration (AMD) is also being explored. Researchers at the Institute of Ophthalmology at University College London are working with nanoparticles to deliver anti-VEGF drugs such as Lucentis and Avasitn to the back of the eye via drops. “The study shows that Avastin can be transported across the cells of the cornea into the back of the eye, where is stops blood vessels from leaking and forming new blood vessels, the basis for wet AMD.” While researchers in the Department of Ophthalmology, Tufts University School of Medicine in Boston “reported in their “proof of concept” study that topical application of a compound called PPADS inhibits damage to the tissues in the eye that impacts the individual’s ability to see color and fine detail, as well as reduces the growth of extraneous blood vessels in the back of the eye related to AMD.” It would work in both dry and wet AMD reduce the need for direct injections.

Eye drops, when properly applied, can provide temporary relief from symptoms of eye discomfort. But if the symptoms worsen or continue for an extended period of time, consult your eye doctor. To make sure you apply the eye drops correctly check out the article in our February 2013 newsletter for 12 easy steps to get the drops into your eyes and avoid infection.

One final note – keep your eye drops out of reach of children. Eye drops come in small bottles that are the perfect size for small hands and don’t have the same security tops found on other medications. The FDA has warned that ingredients found in some eye drops that relieve redness have caused abnormal heart rate, decreased breathing, sleepiness, vomiting and even comas in children five and younger that have ingested them. If you child has swallowed eye drops, call the Poison Help Line 800-222-1222.